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Bad Faith

Recently in California the mother of a dead child organized a demonstration in front of her insurance company. The daughter had been deathly ill and one of her doctors had suggested that they try an organ transplant. The insurance company initially refused to cover this, since they considered it experimental in this case, but eventually they relented after significant political pressure. A week after they agreed to cover it, the girl died. The mother had then sued the company and failed. So she in her grief and outrage was now picketing, and while she and her group were doing this an insurance company employee who was passing through the line flipped her the bird, which was caught on camera.Of course, liberal websites all over the place lit up like Christmas trees over this latest documented proof that insurance companies and their employees are intrinsically evil. The president of the company apologized (we don't know if the worker was fired), but the apology itself was viewed by many as a cynical public-relations ploy.I found that I could relate to both the mother and the worker. I could relate to the mother directly because my younger brother died just a year ago because being uninsured he didn't think that he could seek the liver transplant that would have saved his life. And I can relate to the worker because our industry has become so demonized in the current political environment that for many of us to even admit in company that we work for the insurance industry is to risk what the Irish call a "fla." I have even heard of bloggers who are forced to write under a pseudonym, so strong and dangerous are the pressures both inside the job and outside.

Now on one hand, as a capitalist operative with a capitalist point of view I know that the health-insurance industry is a business that simply grew up around the provision of health benefits to workers. I know that health care is now bracketed out as something special, but as a consumer, if not a Christian, I feel that one could bracket out in the same way all sorts of things such as the right to food, to a roof, to gas, electricity, clothing, etc.But my position as a capitalist operative dovetails in this case with my lifelong propensity to criticize capitalism. If insurance in America is just another capitalist enterprise, demonizing it may not only cause us to NOT see how the industry is really structured, demonizing one type of enterprise against all the other enterprises serves to support capitalism as such. If one group is simply operating in bad faith, it follows that the rest of the system must be sound except for these bad eggs.Insurance as a capitalist enterprise has until relatively recently been a success within its parameters of providing medical coverage as a benefit for workers while supporting an underlying price structure for services that cover all of the expensive innovations that the American health-care system is noted for. The Right is correct in this. But the insurance industry has failed in what was never its goal in the first place; to provide cheap and complete health care benefits for everyone. And the Right is incorrect here when they take the Pollyanna approach and say that the free market will simply fix this.On the other hand, the Left is wrong when it brackets out insurance companies for demonization and then looks for the structural proofs of our personal moral failures. American insurance is part of what American health care is in American capitalist society. It is no more and no less ethical than any other capitalist enterprise. Its failings are the failings of any capitalist enterprise and its strengths are the strengths of any capitalist enterprise. The man with the bird that I mentioned at the beginning is frustrated because he feels that he is arbitrarily being singled out. He knows, as we all know in this business, that one could just as easily demonize the doctors, the hospitals, or the approach of the general consumer to health, life styles, old age, and death. It all fits together, not only as the moral system that we call capitalism, but as an economic structure; as tight as the inner structure of the watch on your wrist.And the most frustrating thing for me as a Christian working inside the business is that both the Left and the Right seem to be entirely missing the point.

Comments

Dear unagidon,I'm sorry to hear about the loss of your brother.If you need a product or service, markets work better than any of the alternatives to get them to you - if you have money. If you don't, you're irrelevant to the working of the machinery. FWIW - I'm trying - so far, without much success - to assist a St. Vincent de Paul client who has no money, no job, no home, no means of transportation - and, needless to say, no medical insurance. He accidentally sustained a minor cut some time ago which, because it wasn't treated properly, developed into an infected wound that required surgery. The local hospital admitted him and performed the procedure, despite his inability to pay, and then - as is the wont of hospitals - discharged him as soon as possible. The doctor prescribed some follow-up therapy, and instructions for fresh bandages for the wound site. He was dumped with no place to go, no way to get anywhere, and no money to pay for the treatment he needs. He has been staying in a cheap motel for the last couple of weeks, thanks to the generosity of a local government agency and a local church - both of whom have limited resources and can't put him up indefinitely. What he is asking of me is money to pay for clean bandages, and some food (but nothing that needs to be prepared - he lives in a motel). We can help him with those things, which will keep him at the status quo for another few days. After that, he will spiral downward to an even lower place than he is now.

I know personally of one case (a relative) in which an insurance company covered expenses of more than $1 million for (unsuccessful) treatment of a rare type of stomach cancer. I wonder why these cases are hardly ever publicized.

Unagidon, I think insurance fails as a capitalistic endeavor in important ways that are different from other capitalistic endeavors. First, because the job of insurance is to spread costs, as has been talked about ad nauseum, people really don't understand costs well at all -- they certainly understand their insurance premiums or employee contributions, but they are often in shock when they are forced to contemplate what the actual cost of care is. This is so radically different from the normal free market principles that it all but guarantees distortions in the supply/demand curve. The fact that services are considered to be "essential" further distorts the market, because, if it's you or, for the Sarkisians, their daughter, they don't really want to hear about efficacy.So I will flog my dead horse further: Natalyne Sarkisian probably should not have had a second transplant because it was virtually doomed to fail. However, it is one thing for the Medicare or another public program to enunciate coverage limits based on what it deems to be the best available evidence, for the good of taxpayers and taxpayer funded programs, it is quite another for a for-profit insurer to make the same decision because even if it is correct, as it very often is, many people find it simply intolerable that the decision might be made as a result of individual profit motives. In other words these denials quickly devolve into a grievance that overlooks all rational medical evidence to jump to the conclusion that "my life is ALWAYS worth more than your profit." Thus, the true costs of medical care are hidden, and hard choices are made even harder and less likely to be acceptable, when private insurance is the easily scapegoated vehicle through which health care is delivered. I am sorry for your brother's loss. My father died without insurance, and the feeling of helplessness only compounds the grief.

Jim, your friend will spiral down not only because of his lack of covered health care but for all the other things that will make him end up living on the street. Because we like to tell ourselves at a nation that we don't let people die in the streets as they do in Calcutta, your friend can count on getting the minimum to keep him alive until he in fact ends up dying in the street.From where I am sitting I think that the issue of caring for people like this is a different one from the general health care issue. But they are mixed in the popular mind. While both are problems that need to be solved, I think that mixing them makes it harder to solve them then detaching them would be.

"However, it is one thing for the Medicare or another public program to enunciate coverage limits based on what it deems to be the best available evidence, for the good of taxpayers and taxpayer funded programs, it is quite another for a for-profit insurer to make the same decision because even if it is correct, as it very often is, many people find it simply intolerable that the decision might be made as a result of individual profit motives. In other words these denials quickly devolve into a grievance that overlooks all rational medical evidence to jump to the conclusion that my life is ALWAYS worth more than your profit. "Hi, Barbara, don't you think, though, that if it were a government body like Medicare that denied coverage, the patient's family would still feel victimized, but their anger would be directed, not at profitability, but at faceless bureaucrats, or whatever it is about big government agencies that enrages us?

Medicare denies coverage all the time. The difference is that it does so in a fairly transparent way and automatically provides for an appeal to an independent medical review, if you want one. I am virtually certain that Medicare would not have covered this transplant.

I wonder why these cases are hardly ever publicized.Probably for the same reason that we don't get reports about the planes that don't crash. The insurance company undoubtedly covered those costs because they were obligated to because of the type of policy involved. Insurance companies don't pay claims to be compassionate, nor should they be expected to. I have had significant medical expenses this year, and I couldn't be happier with my insurance coverage from United HealthCare. However, if you go to Google and do a search with "United HealthCare" and "fine," you will find case after case of government action against the company for unacceptable practices, with fines imposed of up to $50 million dollars. Here's something I was shocked to read in The New York Review of Books:

In congressional testimony on June 16, insurance industry executives from WellPoint, UnitedHealth Group, and Assurant refused to end a controversial practice known as "rescission." Under rescission, insurers retroactively canceloften on the basis of dubious claims that policyholders haven't disclosed their complete health historiesthe coverage of those who develop expensive medical conditions. That has left many people with costly medical bills for treatments that had been previously authorized by their insurance. As Lisa Girion reported in the Los Angeles Times, the three insurers that were included in the June 16 hearing "canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period." In doing so they sought to avoid paying for the treatment of "policyholders with breast cancer, lymphoma and more than 1,000 other conditions."There is no stronger indictment of American private insurers or better example of the profit motive's corrosive influence on medicine than rescission. That insurers, even with political pressure for reform, would not forswear this practice in public hearings is stunning. It also illustrates how difficult a task it will be to transform the business practices of an industry that profits from discriminating against sick people.

This is not to say, however, that insurance companies are always wrong. Both my mother and sister worked paying health insurance claims for a major insurance company, and they both had regular encounters with dishonest policy owners who were trying to defraud the company (usually by trying to get reimbursed for the same expenses by two companies) and with customers who were extremely abusive. They had a little formula to politely recite before hanging up on abusive customers, although in actual practice they just stayed on the line and took the abuse.

David quoted: "In congressional testimony on June 16, insurance industry executives from WellPoint, UnitedHealth Group, and Assurant refused to end a controversial practice known as rescission. Under rescission, insurers retroactively canceloften on the basis of dubious claims that policyholders havent disclosed their complete health historiesthe coverage of those who develop expensive medical conditions. That has left many people with costly medical bills for treatments that had been previously authorized by their insurance."Insurance, any insurance, is nothing more and nothing less than spreading individual risk over the largest population possible. On this basis alone, single payer makes actuarialy sense, since "everyone" is the largest population possible.But we don't do that. So we have to make risk calculations about the people whom we do insure. From our corporate point of view, what we don't want is for people to only buy insurance when they get sick. It would be like people only buying life insurance when the doctor tells them that they have a terminal illness.So when you buy insurance, you are asked a series of questions and the actuaries (in aggregate) determine what the risk profile is of the entire covered population and this in turn determines what the premiums are going to be. Insurance companies are in the risk business and are making a bet that their forecasts will be correct. And this is a good way to ensure that.However, many people don't know about their own "pre-existing condition" in the sense that they don't know what prior medical problems they had are relevant to the risk calculation I have outlined above. Or sometimes, being afraid, they don't admit that they have conditions. And sometimes it can be very gray as to whether some illness in the past is really a continuation or contributer to some illness in the present.This whole situation would go away immediately IF we eliminated all existing condition clauses and questions from insurance applications. But then this would make it very hard to assess the risk level of the current population. At the very least, insurance companies would raise their premiums to above what they probably should be so they could reserve against people who came in ill but didn't say anything about it.OR, one could expand the base of insured to its widest possible extent. Short of a single payer system, the only other way to do this is to mandate insurance coverage for everyone. This would both spread the risk as thinly as possible (over the widest area) but it would also start making populations from payer to payer look more alike in their risk profiles.

Bob said: "I thought Obama, aka The great Unifier was going to put an end to this kind of acrimony. Oh wait, it was he who attacked insurance greedy insurance companies the other day. Way to go Obama"Obama is a politician. We will see eventually how good a politician he is.

"This whole situation would go away immediately IF we eliminated all existing condition clauses and questions from insurance applications. But then this would make it very hard to assess the risk level of the current population. At the very least, insurance companies would raise their premiums to above what they probably should be so they could reserve against people who came in ill but didnt say anything about it."I believe this has been the experience in Massachusetts?

If anyone can enroll at any time, you will get people who will not enroll until after they get the terrible diagnosis. They will pay a small amount and get large benefits that will be paid for by everyone else. But if everyone is required to enroll in the first place, they will already be paying for it so it won't matter.

"Insurance as a capitalist enterprise has until relatively recently been a success within its parameters of providing medical coverage as a benefit for workers"Depending on what you mean by "relatively recently" I am probably going to disagree with you. Half of people receiving healthcare from their employer, and the vast majority who work for large companies, are actually participating in employer self-insurance plans though few of them realize this. Despite the fact that the insurance company is not doing any insurance at all in these cases but is simply acting as a payments processor, it receives all sorts of unjustified goodwill because people think Aetna/Cigna/UnitedHealth/etc were so nice about paying their claims when in reality the company was just doling out other people's money.

MEP said: "Depending on what you mean by relatively recently I am probably going to disagree with you. Half of people receiving healthcare from their employer, and the vast majority who work for large companies, are actually participating in employer self-insurance plans though few of them realize this. Despite the fact that the insurance company is not doing any insurance at all in these cases but is simply acting as a payments processor, it receives all sorts of unjustified goodwill because people think Aetna/Cigna/UnitedHealth/etc were so nice about paying their claims when in reality the company was just doling out other peoples money."This is an important part of it, but not the whole picture.What insurance companies also do is sell discounts to providers. Part of this is provided by the contract that the payer has with the provider directly. And ASO (Administrative Services Only) customers as you point out buy into these discounts. But insurance companies also reduce claims costs. They can't reduce them as radically as they did in the old days when one would spend 10 days in the hospital getting one's appendix out (reduced now perfectly safely to a day or two). But insurance companies make much of their margin getting providers to cut costs by promoting treatment standardization and other things.The individual member does not see this, although the HR risk manager at the company does. On the other hand, the individual member does seem to think that medical costs somehow are static and it is the insurance companies that are just arbitrarily raising prices.

Some suggestions: AHIP via Ignagi, their spokesperson, had agreed to work with the administration until last week. They then paid for a number of ads that stated false and incorrect information and tried again to scare folks. It is not Obama who failed; it is the insurance companies who put into play attack ads.The result of this will probably be Congress voting to pull the long standing tax exempt status that they have had - good; that should bring in a few hundred billion to cover the cost of expanding coverage.Latest polls suggest that 57% of Americans favor a public policy. I have worked in healthcare for 20+ years - am proud of some of the cutting edge treatment and best practices that we have developed but am also very aware of the massive amount of paper waste, time waste, and hoops ordinary Americans have to jump through because of board of directors who focus on stock price, profit margin, etc. Healthcare employees, hospitals, MDs can also be the target of unsavory insurance practices. We need comptetition.Unfortunately, there is no "common good" concept in capitalism. We need the balancing act of goverment. We all can come up with extreme cases that are either good or bad - so what? The bottom line is:a0 all folks deserve insurance;b) it needs to be affordable;c) it needs to get rid of pre-existing conditions, limitations, etc.d) it needs to lower costs by moving away from FFS procedures;e) it needs to protect life, support wellness;f) needs to control costs of Medicare/Medicaid;g) needs to address the Amrican culture around death and dying - we can not have it both ways - unlimited, exorbitant care vs. common good.The pain needs to be spread around.

"many people find it simply intolerable that the decision might be made as a result of individual profit motives. In other words these denials quickly devolve into a grievance that overlooks all rational medical evidence to jump to the conclusion that my life is ALWAYS worth more than your profit."My mother, in her short hospital stay last Spring before she died, was wondering every day how much her care must cost and how much work her presence created for the hospital staff, and was greatly perturbed by the thought that their time and money would, as she thought, probably be better spent on other sick people. Not everyone wants to grab as much health care as they are possibly can! But it was in France, and non-profit: it's one thing to want to forego care so that, say, the hospital pediatrics ward has more resources. And quite another to do it so that the company makes more profit!!

Bill, insurance companies are not tax exempt. Tax exempt insurance companies are tax exempt.You're right about the pain needing to be spread around. This is not something that sells well in the US, where life, liberty and the pursuit of happiness would seem to point people in another direction.

In 1986 Congress declared by law that the provision of insurance was not a charitable activity and could never form the basis of tax exempt status, and that the insurance related revenues of tax exempt organizations would be taxable as unrelated business income. Insurers are not tax exempt.

I suppose I'm mostly on the Left, but I agree with Unagidon's comment here: "On the other hand, the Left is wrong when it brackets out insurance companies for demonization and then looks for the structural proofs of our personal moral failures." A reason people are losing health insurance is because they're losing their jobs and because more employers are hiring just-below-full-timers to lock them out of insurance benefits, which saves employers money or allows employers to preserve health insurance for some employees in the face of increasing rates.Increasing costs of medical care forces insurance companies to drive up premiums in order to maintain profits for shareholders and cover the insured. In some cases, insurance companies try to hold down the cost of care by negotiating lower rates with health care providers. Unfortunately, health care providers who cut low-cost deals with one insurance carrier may pass the difference along to those insured with companies less willing/able to negotiate. And those of us without any insurance company to negotiate for us will pay the full sticker price. "This American Life" (NPR) offered some interesting perspectives on the history of job-related health insurance and some of the forces creating problems today.http://www.thisamericanlife.org/Radio_Episode.aspx?episode=392

"A reason people are losing health insurance is because theyre losing their jobs and because more employers are hiring just-below-full-timers to lock them out of insurance benefits, which saves employers money or allows employers to preserve health insurance for some employees in the face of increasing rates."Yes. The availability of any single-payer or public option will result in American companies dumping their employee insurance benefit en masse. No rational corporation will pay for insurance if they don't have to.jp

Another complicating factor: http://news.yahoo.com/s/ap/20091021/ap_on_go_co/us_health_overhaul_shiel... mistake - not tax exempt status by removing anti-trust protections for large insurers:http://www.mcclatchydc.com/homepage/story/77523.htmlHighlights:Consumer groups are convinced that ending the exemption would prompt insurers to compete with one another more energetically. The current practice, said Jim Guest, the Consumers Union chairman, is "bad for consumers, bad for patients and bad for taxpayers."The push to end the exemption will have the backing of Senate Majority Leader Harry Reid, D-Nev., who appeared with Leahy at a Capitol news conference."The case for action is very simple," Reid said. "When companies are forced to compete with one another, that's what our free enterprise system is all about, and when you have one industry that has no referee . . . you never win the ballgame."America's Health Insurance Plans, the industry trade group, fought back quickly."Health insurance is one of the most significantly regulated areas of the economy," Karen Ignagni, president and chief executive officer, wrote Wednesday in a letter to Leahy and Conyers."AHIP and our members stand on the side both of competition and of meaningful reform," she said.Insurance has been largely under state regulation since an 1868 Supreme Court decision ruling that insurance isn't interstate commerce and therefore not subject to federal regulation.The high court reversed that finding in 1945, but according to the Congressional Research Service, state regulation was so well established that Congress granted a federal antitrust exemption to those engaged in the "business of insurance," leaving most authority with the states.Several factors have combined to make this year's push for change significant, including broader scrutiny of the financial services industry and efforts to revamp regulatory law.The push to end the antitrust exemption has been building for some time. In his weekly radio address Saturday, President Barack Obama noted that insurers are "earning these profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing."In addition, House Speaker Nancy Pelosi, D-Calif., said, "It is clear where the problem has been. It is absolutely clear that it is an unsustainable situation as we go forward, and it is well known to the public that the health insurance companies are the problem."

My objection is not that insurance companies are demonized but that they're demonized for the wrong reasons.When such coverage issues come up, insurers can always disclaim moral responsibility by telling us that they're captive to market forces over which they have no control. On the other hand, they seem to have been at the forefront of those who vote with their dollars to oppose any changes to that very same system. It seems to me that what they really fear is any changes in the system that might jeopardize their very lucrative business model.It's disengenuous for those who have such a powerful role in deciding how the game is played to evade responsibility by telling us they're only following the rules.

We have come a long way in treating the stigma of mental illness - with the Mental Health Parity act finally passing because it was added to the bail out bill last September.But, can remember when putting down any type of mental health disease e.g. depression, psychosis, anxiety, etc. could jeopardize getting insurance or renewing insurance policies. We don't seem to have come that far.

Antonio said: "It seems to me that what they really fear is any changes in the system that might jeopardize their very lucrative business model."Let's look at this.Any capitalist enterprise is going to act this way to some degree, because changing always involves costs and frequently involves uncertainty. But the insurance industry is not just reacting to this.We actually do discuss among ourselves the question "If I were Obama and I wanted to reform health care, what would I do?" And we are quite divided about it. There are some who want no change, but not just for the reason you might think. They actually think that our job is to provide insurance for employer groups and that's about it. Supplying insurance for other people, especially if they can't afford it, simply isn't our job any more than it's the job of General Mills to provide cereal to people who can't afford to buy it.There are others who do want change (because whatever you might think, there is no one who knows how and why the system is broken better than we do), but they look at it as a business problem like any other, so they ask "What can WE really do and how can we do it given our own resources?" Part of this is defensive, in that people don't want to work themselves out of a job. But part of this is practical; they really think that shutting down the insurance companies and starting over from scratch is simply a bad idea. It's a resource issue to them.There are others who look to radical changes. These people may be more far sighted than the rest. They are the ones who might consider what it would take to get to a single payer system. There are not many of them; not because we are all intrinsically greedy but because American business is and has been for a long time geared to short term results. People like this, from their experience rather than their greed, think that the system needs to be rebuilt, but to do it will require changing insurance, providers, drug company behavior, and consumer behavior. It won't be a short term thing and it is not something that can be simply mandated by anyone.Since insurance companies have been particularly demonized in the current process, when they say things like "insurance is about spreading risk; therefore it needs to be spread as widely as possible; therefore, if we eliminate "pre-existing conditions" we have to expand the risk pool; therefore the purchase of insurance has to be required of everyone," the public simply sees this as an attempt to expand market share rather than what it is, which is sound actuarial thinking.I am not saying that capitalism does not enter the picture and that the profit motive isn't part of this. Of course it is. This is America. But keep in mind that unless we were to really socialize the economy (as socialism really is; the ownership of the means of production by the state) capitalists will find a way to be involved in, if not dominate, ANY solution that the government comes up with. (Show me one where they don't.) So if someone from the insurance lobby says "If you do X, the bad thing Y will happen" don't automatically assume that they are simply lying and that if an insurance company says that something is bad, it's proof that it is actually good.

Thank you for that, Grant. This is one of those appalling things that I don't think gets addressed enough by insurance companies. Let's look at what's going on.Here is a quote from the article:"Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free."In a nutshell, a woman is raped. Later, she loses her employer provided insurance and now has to go to the market and buy individual insurance. When she was raped, her doctor wisely enough put her on HIV medication for a while because he didn't know whether she had been exposed to HIV so he assumed that she had been. It's part of universal precautions to do this. But when she went to purchase in individual policy, she told the insurance company that she had been on HIV medication. The insurance company then treated her as a high risk HIV patient and refused to insure her. One can say that the insurance company didn't want to insure her because they felt that she would have a lot of claims and in order to protect their profits, they would not take on the risk. This follows the current meme that insurance companies make their profits from not covering people who are sick, and this one idea is probably the real thrust behind people's anger with insurance companies.But this is only half true. Insurance companies exist to provide benefits to employer groups that want to give these things to their workers. This is the way that it is in America. What this means is that insurance companies to compete with each other (and they do compete with each other) have to try to keep premiums down.A particular feature of the individual insurance market is that while many people that buy individual policies do so because they simply want to continue their lost employer policies, others will buy it because they are sick. In the case of the latter, what they are doing is trying to pay their premium (let's call it $500 per month) in order to get far more benefits than that. There is no business model that could survive this. So insurance companies look very carefully at situations where someone with a chronic illness might try to buy insurance because they want to get much more than they will be paying (and they know it). Hence, you see things like the article speaks about. The insurance company does not want to pick up individual HIV patients who are buying insurance because they have HIV. So the insurance company will screen out anyone who looks like they might have HIV (from individual policies). The people being screened out are screwed, of course. But not because insurance companies are simply greedy and could insure such people if they wanted to. It is because of the way that insurance is set up in the United States. Insurance has NEVER been set up to insure everyone no matter what.If you want someone, anyone, to insure everyone no matter what, you will have to find a way to pay for sick people who are going to spend very little in premiums compared to the benefits they get. You will have to subsidize these people with the tax system. Or you will have to require absolutely everyone to be insured. Right now we do not have either of these in (wide) operation in the US. And that is what much of the health reform is all about.

We actually do discuss among ourselves the question If I were Obama and I wanted to reform health care, what would I do? And we are quite divided about it. Regardless of what discussions take place behind closed doors, the public face of the insurance industry is still reflected in the "Harry and Louise" ads that killed the Clinton plan. As far as I can tell, there have been no visible cracks in that faade. There are some who want no change, but not just for the reason you might think. They actually think that our job is to provide insurance for employer groups and thats about it. Supplying insurance for other people, especially if they cant afford it, simply isnt our job any more than its the job of General Mills to provide cereal to people who cant afford to buy it.As Im, sure youre aware, the issue isnt a companys refusal to sell at a loss, The better analogy is a firm that works to preserve market share by preventing competitors from selling the same product more cheaply and at a profit.[I]f someone from the insurance lobby says If you do X, the bad thing Y will happen dont automatically assume that they are simply lying and that if an insurance company says that something is bad, its proof that it is actually good.It isnt a matter of truth or falsehood but a problem with credibility that the industry has inflicted on itself. Its the classic problem of asymmetric information.

Jean: A reason people are losing health insurance is because theyre losing their jobs and because more employers are hiring just-below-full-timers to lock them out of insurance benefits, which saves employers money or allows employers to preserve health insurance for some employees in the face of increasing rates.Jim P.:Yes. The availability of any single-payer or public option will result in American companies dumping their employee insurance benefit en masse. No rational corporation will pay for insurance if they dont have to.Jean again: In a better economy, where employers have to compete for workers, I can envision a system where there is a public, basic care program, but where employers offer supplemental insurance that enhances the basic, public option in some way. Moreover, employers are already dumping health insurance en masse, which, without a public option, leaves workers without any coverage whatever. Seems to me that some smart number cruncher somewhere could look at how big the population of uninsured are and what they cost the system now (and what they would cost the system if they didn't forgo medical treatment for lack of $$). Might make the costs of universal care look a lot more reasonable. Also a new development for those of us who are uninsured: Some doctors are urging patients who have lost health care to seek doctoring through departments of public health, ostensibly because uninsured patients can get free and low-cost screenings. Sadly, most public health departments have cut services and hours due to lack of state funds. Clearly, doctors in private practice get hinky treating patients who don't get yearly blood work, mammograms, bone density tests and the like because they can't afford it.